Few seniors go for Medicare wellness visits

Medicare, long criticized for kicking in only once people got sick, last year started paying primary care physicians to talk to their senior citizen patients once a year about staying healthy.

Apparently, there aren't a lot of those discussions happening.

An analysis released recently by the Centers for Medicare and Medicaid Services showed only 8 percent of the 2.4 million elder and disabled Floridians on Medicare Part B, which pays for doctor's visits, had the new wellness screening in 2011.

On a national level, 2.3 million of traditional Medicare's 35 million participants had their wellness visit last year, or about 6 percent. That compares with 14.5 million, or 41 percent, who had a flu shot and 20 million, or 57 percent, receiving blood testing for cardiovascular disease.

The reason? Experts think it's a mix of low awareness, physician apathy and limits on how much the screening covers.

"I think it's nice that Medicare is offering an annual wellness visit. But it's not the same as an annual physical exam. It doesn't offer much more than recording some information," said Dr. Joel A. Danisi, director of clinical geriatrics at the University of Miami's Miller School of Medicine.

Danisi believes some doctors may view the wellness exam as duplicating what they already do for their older patients. "But I think it's perfectly reasonable for a patient to request one if they want it," he said.

Leonard and Eunice Rose, both in their 80s, buy additional insurance to cover what Medicare does not. They also pay extra for a medical concierge practice, where patients are charged additional fees to ensure shorter wait times and longer visits.

But they had not heard about the wellness visit, covered by Medicare at no cost to them, until they went to a Delray Beach center specializing in preventive medicine two months ago. "Our doctors never told us about [the benefit]," said Eunice Rose, of Aventura.

The program for years has offered what it calls the Welcome to Medicare checkup, given to new enrollees. It includes a vision test and body mass index calculation. Doctors also take the patient's family medical history, review their medications and vaccines and discuss appropriate routine screenings.

The new wellness visits, done annually after the welcome checkup, just cover basic medical review and routine measurements such as blood pressure readings. Annual physical exams tend to be more comprehensive and often include blood work or screenings, Danisi said, but the office visit for a physical is not covered by Medicare.

David Lipschutz, policy attorney for the Center for Medicare Advocacy in Washington, D.C., thinks seniors and doctors remain confused or unaware of the new benefit, and said Medicare might fine-tune it if more people don't use it. "But I am sure it can benefit a lot of people if they know about it," he said.

Medicare officials did not answer questions about why the wellness exam utilization rates might be so low. Spokeswoman Lee Millman said the federal agency continues to run education campaigns about preventive benefits, and offers brochures as well as information online.

The wellness visit was added to Medicare under the Affordable Care Act, effective January 2011, along with alcohol misuse screening and counseling and depression screens. The legislation also eliminated co-payments and deductibles for other prevention measures including bone density measurements, cancer screenings and smoking cessation counseling.

Late last year, the federal health insurer announced it also would pick up the tab for obesity screening and intensive behavioral therapy for beneficiaries with a body mass index over 30. Those sessions must be done by in a primary care office, not a specialized clinic or hospital.

The recent Medicare report did not give utilization rates for other new screenings.

Dr. Steven Charlap, who formerly led a national company that treated nursing home patients, teamed his personal interest in holistic medicine with Medicare's growing prevention benefits for his latest venture.

His MDPrevent center, opened late last year in Delray Beach, focuses on services such as behavior counseling, exercise, diabetes management and weight control rather than traditional primary care medicine. The center has its own kitchen, where a dietitian demonstrates healthy cooking techniques, and MDPrevent will have the new Medicare-sanctioned obesity counseling program.

Despite the low wellness exam utilization rates, Charlap thinks Medicare will keep investing in preventive measures. He has applied for a federal grant to expand his MDPrevent model.

Seniors often aren't aware that Medicare now reimburses for preventive services, Charlap says. Some MDPrevent patients, like Marcia Howard of Deerfield Beach, are drawn in by the free wellness exam and surprised by what they learn. In Howard's case, she discovered she possibly was pre-diabetic. "I now know I have to change my diet," she said.

The Roses were impressed by how much time the MDPrevent staff spent with them on their first wellness visit. Leonard Rose, with health conditions including Parkinson's disease, arrived with a bag containing the dozen medications and supplements he was taking daily. "They took him off what he didn't need and gave me some ideas on how to get Leonard walking more," Eunice Rose said.